P - 78326REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1� 3 4 7- 411 �u�` 1821 ����e�s�� A�e��e S��te S-,28, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request: � s
❑NEW �[iEMODEL pADDITION ❑REPAIR
GENERAL FEES
SERVICES I POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Ampere � $50
Above 800 Ampere (� $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNITI
OTHER ADDITIONAL FEES
Lighting Retrofit � $.25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots (� $25
Recreational Vehicle Park Sites � $5
ipecial Inspection (� $30 per Hour
ipecial Inspection � $.31 per Miie
ic � �� , ��° 1 +�1
�
� .... � ...
��
l�= .�
�
Outdoor Li hti� Standard � $1
Traffic S' nal Standard � a5
Su demental Fee � S20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I tor Si ns / Outline Li htln (� $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Tri s Each Dweliing Unit �$8C
Additional Ins ection Tri s(� $20
Investiqative Fee
Reinsoection Fee � $20
ivu� rcc
total fee is $201 Z �
thatlinspected ihe eledricalinstallallon described herein on ihe dates stated:
� - on�
�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N�T COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
��7�`�
� ��Ei�� rrRi� ��c�� �i��� iii�� ii�i� �ii�� �ri�� �i�� ii�r J(_ .
�E 1 3 4 7 4 1 1 9 iE �� � Q! J� � S�
Request Date: Rough-in Inspection Fiequired? ❑ Yes No Inspection Other Than Rough•In: ❑ Ready Now ill Call
9��� V You must call the inspector when readyl - Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
��r �
Power Sup;,lier
� F.r �1r�-��,��
Mailing Address (Contractor, Company or
//1/LWV
BOARD OF ELECTRICRY COPY
INSTRUCTONS ON BACK OF YELLOW COPV